Provider Demographics
NPI:1699382978
Name:KIM, YOUNG RON (NP-C)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:RON
Last Name:KIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:1306 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7946
Practice Address - Country:US
Practice Address - Phone:940-382-5005
Practice Address - Fax:940-382-5803
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily